Kuwayama H, Asaka M, Sugiyama T, Fukuda Y, Aoyama N, Hirai Y, Fujioka T
Department of Gastroenterology and Hepatology, University Hospital at Koshigaya, Dokkyo University School of Medicine, Koshigaya, Japan.
Aliment Pharmacol Ther. 2007 May 1;25(9):1105-13. doi: 10.1111/j.1365-2036.2007.03298.x.
Large-scale studies of rabeprazole-based Helicobacter pylori eradication therapy have not been reported in Japan.
To evaluate H. pylori eradication by rabeprazole-based therapy with reference to antibiotic susceptibility, CYP2C19 genotype, and rabeprazole and clarithromycin dosages.
From 35 centres 479 H. pylori-positive patients with gastric or duodenal ulcer were randomized to four treatment groups: Group 1 (10 mg rabeprazole + 750 mg amoxicillin + 200 mg clarithromycin twice daily for 7 days); Group 2 (10 mg, 750 mg, 400 mg); Group 3 (20 mg, 750 mg, 200 mg) and Group 4 (20 mg, 750 mg, 400 mg).
Eradication rates were 86% (102 of 119), 89% (97 of 109), 91% (106 of 116) and 90% (104 of 115) for Groups 1-4, respectively. The eradication rate was 95% (360 of 379) for clarithromycin-susceptible strains, and 50% (30 of 60) for clarithromycin-resistant strains. The eradication rates were 88% (332 of 379) and 96% (77 of 80) in extensive metabolizers and poor metabolizers, respectively.
Rabeprazole-based therapies achieved 50% eradication of clarithromycin-resistant H. pylori, and even achieved good rates in extensive metabolizers. Accordingly, rabeprazole can be recommended as part of a first-line proton pump inhibitor-based triple therapy for H. pylori.
日本尚未有关于基于雷贝拉唑的幽门螺杆菌根除治疗的大规模研究报道。
参照抗生素敏感性、CYP2C19基因型以及雷贝拉唑和克拉霉素剂量，评估基于雷贝拉唑的治疗方案对幽门螺杆菌的根除效果。
来自35个中心的479例幽门螺杆菌阳性的胃溃疡或十二指肠溃疡患者被随机分为4个治疗组：第1组（10毫克雷贝拉唑+750毫克阿莫西林+200毫克克拉霉素，每日2次，共7天）；第2组（10毫克、750毫克、400毫克）；第3组（20毫克、750毫克、200毫克）和第4组（20毫克、750毫克、400毫克）。
第1 - 4组的根除率分别为86%（119例中的102例）、89%（109例中的97例）、91%（116例中的106例）和90%（115例中的104例）。对克拉霉素敏感菌株的根除率为95%（379例中的360例），对克拉霉素耐药菌株的根除率为50%（60例中的30例）。广泛代谢型和慢代谢型的根除率分别为88%（379例中的332例）和96%（80例中的77例）。
基于雷贝拉唑的治疗方案对克拉霉素耐药的幽门螺杆菌的根除率达50%，在广泛代谢型患者中甚至也有较好的根除率。因此，雷贝拉唑可作为基于质子泵抑制剂的幽门螺杆菌一线三联疗法的一部分被推荐使用。
